Was PANDAS Associated with Mozart's Personality Idiosyncrasies?

Abstract: The author previously invoked Tourette's syndrome (TS) as a possible explanation for Wolfgang Mozart's written anal scatological wordplay, motor and vocal idiosyncrasies, and motor hyperactivity. It was suggested that Mozart was the recipient of a remarkable genetic background that included his perfect pitch and musical savantism on the one hand, and a TS-attention deficit/ hyperactivity disorder (ADHD) symptom complex on the other. Recently, the concept of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) has emerged as a cause of childhood syndromes of obsessive compulsive disorder (OCD) and/or motor and vocal tics (TS) and motor hyperactivity (ADHD), analogous to the poststreptococcal autoimmune genesis of illnesses such as rheumatic fever and Sydenham's chorea. The objectives of the article are: (1) tabulation of Mozart's documented lifetime infectious illnesses and poststreptococcal sequelae; (2) determining the relationship of Mozart's infectious illnesses to his written wordplay and personality oddities; (3) review of the concept of PANDAS and current diagnostic criteria; and (4) examining the possible role of PANDAS in Mozart's personality idiosyncrasies. During Mozart's childhood and adolescent touring years (ages 6-17), there were a total of 18 documented infectious illnesses, of which at least half were upper respiratory infections (URIs), and three autoimmune streptococcal sequelae. During his early adult Salzburg period (ages 21-24), Mozart had two URIs and close exposure to his mother's four known infectious illnesses on their Parisian journey. During Mozart's adult Viennese decade (ages 25-35), there were a total of ten illnesses and five streptococcal sequelae. Mozart died of an epidemic febrile illness superimposed upon a poststreptococcal glomerulonephritis. Mozart's childhood personality traits included several obsessive behaviors, marching and bedtime rituals, impulsivity, and motor hyperactivity. Peaks of Mozart's written scatological wordplay occurred during his adolescent Italian tours (ages 14-17), his unhappy adult Salzburg years (ages 21-24), and the last year of his life (age 35). There is ample documented evidence of Mozart's lifelong background of numerous infectious illnesses and poststreptococcal autoimmune sequelae (rheumatic fever, erythema nodosum, Schönlein-Henoch syndrome, glomerulonephritis). There is a general correlation between the incidence of these illnesses and peaks of Mozart's scatological wordplay and personality idiosyncrasies, suggesting PANDAS as an additional causative factor superimposed on his genetic and cultural background. The absence of 18th-century laboratory confirmation, and current uncertainty of the time course and longitudinal follow-up of PANDAS render this conclusion tentative at present